UB program lowered A1C levels in diabetics and cut monthly costs by $212 per patient

BUFFALO, N.Y. -- The role of pharmacists hasn't received much
attention in the debate on the cost of health care. But national
and regional studies show that when pharmacists directly
participate in patient care, they significantly reduce treatment
costs and improve outcomes.

A study on diabetic patients by the University at Buffalo School
of Pharmacy and Pharmaceutical Sciences identified cost savings
with improvements in a key indicator of glucose control in diabetes
patients, the hemoglobin A1C measurement. The A1C provides a
three-month average of the amount of excess glucose in the blood.
Higher A1Cs indicate that a patient is at higher risk for
developing long-term complications associated with diabetes, such
as kidney disease or vision problems.

Published last spring in the Journal of the American Pharmacists
Association, the UB study of 50 patients with Type 2 diabetes
demonstrated that in just six months clinical pharmacists, in
collaboration with primary care providers, were able to
significantly reduce patients' A1C levels.

In the UB study, patients' A1C levels were reduced by an average
of 1.1 percent, from an average of 8.5 percent to 7.4 percent, one
year after being enrolled in the program, while also improving the
overall metabolic profile.

These clinical improvements occurred while monthly costs per
patient went down by approximately $212, around $2,500 per year,
even though there were nominal increases in the cost of medications
prescribed.

The key to success?

"Patients had unlimited access to pharmacists throughout the
year," says Slazak.

Patients referred to the UB program had been identified by their
primary care providers as having difficulty controlling their blood
sugar. Slazak notes that it was not uncommon to see patients with
glucose levels as high as 400 mg/dl (normal levels are below 100
mg/dl).

The UB pharmacists spent an initial one-hour appointment with
each patient, where they worked up detailed health records covering
dietary information and all medications and disease conditions, and
then reviewed them with each patient.

After that, patients could call or make appointments with
pharmacists at will.

"We did extensive education with patients about how to manage
their conditions," says Slazak. "In many cases, we were
instrumental in getting them to start insulin. There is a lot of
resistance to that, and not just because it's an injection."

For patients in the initial stages of administering insulin, she
says it was common to be contacted once every few days. The
pharmacists then made suggestions to physicians about changes in
medications, dosages or lifestyle that might be beneficial to their
patients.

That kind of individualized attention is far from the norm for
diabetic patients.

"Nationwide, the standard of care is that the primary care
provider manages diabetes alone," says Slazak. "Pharmacists
typically do not have direct involvement."

That is partly because some states, including New York, have not
yet approved collaborative practice agreements between physicians
and pharmacists. In the Buffalo study, for example, physicians were
required to review pharmacists' recommendations and approve all
interventions first. Completion of the review process and approval
occurred in only half of the cases, potentially limiting the
overall benefit to the patient.

"We know there's a long-term clinical and economic benefit to
pharmacists working directly with patients and we think that can
continue to grow," says Scott V. Monte, PharmD, UB clinical
assistant professor of pharmacy practice and director of Diabetes
and Cardiovascular Research, CPL Associates, LLC, in Buffalo.
"Pharmacists can help achieve better outcomes if given the
chance."

The study was conducted through MedSense™, part of the
Pharmacotherapy Research Initiative, a collaborative effort between
Lifetime Health Medical Group and UB, to study how pharmacists
impact patient care. MedSense™ is one of many program sites
that are part of the UB Pharmacotherapy Research Initiative in the
School of Pharmacy and Pharmaceutical Sciences, which was
established to study how pharmacy medication management can improve
the health of patients while cutting costs through patient-centered
pharmacotherapy.

In addition to Slazak and Monte, other co-authors on the paper
include Nicole Paolini Albanese, PharmD, UB clinical assistant
professor; Martin Adelman, PhD, chief information officer at CPL
Associates, LLC; Gauri Rao, a student in the UB School of Pharmacy
and Pharmaceutical Sciences, and Joseph A. Paladino, PharmD, UB
professor of pharmacy and director of outcomes research at CPL
Associates, LLC.

The program is jointly funded by Lifetime Health Medical Group
and the UB School of Pharmacy and Pharmaceutical Sciences.

The University at Buffalo is a premier research-intensive
public university, a flagship institution in the State University
of New York system and its largest and most comprehensive campus.
UB's more than 28,000 students pursue their academic interests
through more than 300 undergraduate, graduate and professional
degree programs. Founded in 1846, the University at Buffalo is a
member of the Association of American Universities.